INDIANA | IN
| Medical (PMPM) | $15.50 |
|---|---|
| Dental (PMPM) | $3.00 |
| Notes | 90% |
MONTANA | MT
| Medical (PMPM) | $12.00 |
|---|---|
| Dental (PMPM) | $3.00 |
| Notes | 90% |
OREGON (SBE) | OR
| Medical (PMPM) | $17.00 |
|---|---|
| Dental (PMPM) | $3.00 |
| Notes | 90% |
WASHINGTON (SBE) | WA
| Medical (PMPM) | $19.00 |
|---|---|
| Dental (PMPM) | $3.00 |
| Notes | 90% |